Mortality Still Significant in High-Risk PE Despite Advances

Researchers evaluated contemporary care patterns and outcomes of high-risk PE using data from the Pulmonary Embolism Response Team (PERT) Consortium Registry, a prospective collaboration of 35 centers in the United States with dedicated multidisciplinary PERTs.
The cohort included 2976 patients with intermediate-risk PE and 1442 with high-risk PE. The high-risk PE group included 197 patients with catastrophic PE with hemodynamic collapse.
The co-primary endpoints were in-hospital mortality and major bleeding; multivariable regression analysis was used to identify baseline factors independently associated with the primary endpoints.

Patients with high-risk PE were more likely than those with intermediate-risk PE to undergo advanced therapies (41.9% vs 30.2%), including systemic thrombolysis, surgical embolectomy, and mechanical circulatory support, with no difference in catheter-based therapies.
The risk for in-hospital major bleeding increased proportionally with the severity of PE presentation.
In-hospital mortality was 20.6% in high-risk PE vs 3.7% in intermediate-risk PE; it was 42.1% in catastrophic high-risk PE with hemodynamic collapse vs 17.2% in noncatastrophic high-risk PE.
Factors associated with in-hospital mortality were vasopressor use (odds ratio [OR], 4.56), extracorporeal membrane oxygenation use (OR, 2.86), identified clot-in-transit (OR, 2.26), and malignancy (OR, 1.70).

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